Relationship between functional status and fatigue after COVID-19 infection: a multicenter study from Türkiye.

Background/aim: Symptoms of COVID-19 may persist for months. One of the persistent symptoms of COVID-19 is fatigue, which reduces functional status. The relationship between fatigue, functional status, and various other factors has received little attention, which this study aims to address.. Materials and methods: Patients with COVID-19 infection were included in this multicenter cross-sectional study. Age, sex, body mass index (BMI), marital status, smoking status, presence and duration of chronic disease, comorbidity index, regular exercise habits, time since COVID-19 diagnosis, hospitalization status, length of hospital stay, intubation status, home oxygen therapy after discharge, participation in a pulmonary rehabilitation program, presence of dyspnea, presence of cough, presence of sputum, and modified Medical Research Council, Post-COVID Functional Status (PCFS), Fatigue Severity Scale (FSS), and EQ-5D-5L Questionnaire scores were recorded. Results: We enrolled 1095 patients, including 603 (55%) men and 492 (45%) women with a mean age of 50 ± 14 years. The most common chronic lung disease was COPD (11%) and 266 (29%) patients had nonpulmonary disease. The median time elapsed since COVID-19 diagnosis was 5 months; the hospitalization rate was 47%. The median PCFS grade was 1 (0-4) and the median FSS score was 4.4 (1-7). The PCFS and FSS were positively correlated (r = 0.49, p < 0.01; OR: 1.88, 95% CI: 1.68-2.10). Both functional status and fatigue were associated with quality of life, which was lower in older patients, those with higher BMI, those with systemic disease, those not exercising regularly, and those with more severe COVID-19 infection (defined by dyspnea, pneumonia as indicated by computed tomography, hospitalization, length of stay, ICU admission, intubation, and the need for home oxygen after discharge). Conclusion: Fatigue may cause poorer functional status regardless of the time since COVID-19 diagnosis. In this study, patients with FSS scores of >4.78 showed moderate to severe functional limitations. It is important to address modifiable patient risk factors and reduce the severity of COVID-19 infection.

Electrocardiogram parameters for predicting future arrhythmia in patients with stable chronic obstructive pulmonary disease.

Introduction: Arrhythmia is one of the common comorbidities in chronic obstructive pulmonary disease (COPD). The aim of this study was to evaluate arrhythmia predictors by using ECG in non-hypoxemic patients with stable COPD in outpatient clinics. Materials and Methods: Fifty patients with COPD and 21 age-sex matched healthy controls were enrolled. Exclusion criteria were having history of exacerbation in the last two months, any cardiac symptoms, comorbidities, hypoxemia for COPD patients, and additionally, history of smoking for healthy controls. Twelve-lead ECGs were obtained from all patients. Result: Mean was 55 ± 4 year in all participants. Median Medical Research Council (MRC) score of COPD patients was 2 and median value of FEV1 was 49%. Median heart rate of COPD patients was 77/min with normal sinus rhythm, significantly faster than healthy controls. P-min, QTcmin, Tp-edisp, Tp-e/QT were significantly different from the control group. In patients with COPD, whilst significant correlations between pulmonary functions and Qtcmin, Qtc-max, p-min were found, there were no significant differences between groups of spirometric stages. Smoking and mMRC dyspnea scale were not correlated with ECG findings. Conclusions: This study showed that non-hypoxemic COPD patients with decreased pulmonary functions, without cardiac symptoms and comorbidities, could have risks for atrial, ventricular arrhythmias regardless of dyspnea, smoking.

Use of i-BODE index to determine efficacy of pulmonary rehabilitation in COPD patients.

INTRODUCTION: Pulmonary rehabilitation (PR) is well-proven approach on improving dyspnea, exercise intolerance which are two components of BODE index. But, PR is known to have minimal effect on pulmonary function which is another component of BODE index. There are few studies evaluating PR efficacy by using i-BODE index. Our aim was to evaluate efficacy of PR in patients with chronic obstructive pulmonary disease (COPD) with i-BODE index and to investigate changes in i-BODE index according to GOLD 2011 combined assessment. MATERIALS AND METHODS: A total of 228 stable COPD patients who completed a comprehensive 8 week duration PR program were enrolled into this retrospective study. RESULT: The patients were with mean age of 63.3 ± 8.6 years and mean FEV1% was 38.6 ± 16.2%. According to combined assessment of COPD, 23 patients were group A, 30 patients were B, 31 patients were C and 144 patients were D. Baseline i-BODE scores correlated with body compositions, pulmonary function, dyspnea, exercise capacity, psychological status, quality of life, and age. i-BODE index score decreased from 4.7 ± 2.2 to 3.5 ± 1.8 after PR (p<0.001), improved by 26%. Significant improvements were found in dyspnea, quality of life and i-BODE index in more symptomatic patients (group B and D). CONCLUSIONS: This study highlights that changes in i-BODE scores after PR significantly correlated with improvements in dyspnea, exercise capacity and quality of life. i-BODE score could be a better predictor of efficacy of PR than some individual variables such as BMI or FEV1. Significant improvements in dyspnea sensation, quality of life and i-BODE index could be seen symptomatic patients in after PR.

Non-invasive ventilation during cycle exercise training in patients with chronic respiratory failure on long-term ventilatory support: A randomized controlled trial.

BACKGROUND AND OBJECTIVE: The role of non-invasive ventilation (NIV) during exercise training (ET) in patients with chronic respiratory failure (CRF) is still unclear. The aim of this study was to test whether NIV during ET had an additional effect in increasing the 6-min walking distance (6MWD) and cycle endurance time compared with ET alone. METHODS: All patients underwent 20 sessions of cycle training over 3 weeks and were randomly assigned to ET with NIV or ET alone. Outcome measures were 6MWD (primary outcome), incremental and endurance cycle ergometer exercise time, respiratory muscle function, quality of life by the Maugeri Respiratory Failure questionnaire (MRF-28), dyspnoea (Medical Research Council scale) and leg fatigue at rest. RESULTS: Forty-two patients completed the study. Following training, no significant difference in 6MWD changes were found between groups. Improvement in endurance time was significantly greater in the NIV group compared with the non-NIV training group (754 ± 973 vs 51 ± 406 s, P = 0.0271); dyspnoea improved in both groups, while respiratory muscle function and leg fatigue improved only in the NIV ET group. MRF-28 improved only in the group training without NIV. CONCLUSION: In CRF patients on long-term NIV and long-term oxygen therapy (LTOT), the addition of NIV to ET sessions resulted in an improvement in endurance time, but not in 6MWD.

[Oral nutritional supplement in patients with COPD who completed PR program: six months and one year follow ups]. / Pulmoner rehabilitasyon programini tamamlayan KOAH tanili olgularda oral nütrisyonel destek; alti ay ve bir yillik takipleri.

INTRODUCTION: Oral nutritional supplement (ONS), an important part of multidisciplinary pulmonary rehabilitation (PR) program, is indicated according to body composition abnormalities in the patients with chronic obtructive pulmonary disease (COPD). We evaluated efficacy of oral nutritional supplement (ONS) during 5-8 months in patients with COPD who completed PR program. MATERIALS AND METHODS: The data of 41 patients with stable COPD were recorded after the approval had been taken. Patients were grouped according to ONS duration. Group 1 consisted of patients who took ONS during 2 months, group 2: 5 months, group 3: 8 months. In all patients, pulmonary function tests, quality of life, exercise capacity and body composition datas were recorded before and after PR program, at 3rd, 6th month and in 20 patients 1 year follow-up visit. RESULT: In all groups, improvements after PR in exercise capacity, dyspnea, and body composition sustained at 3 and 6 month. Quality of life was protected in group 1 during six month, in other groups it was over values before PR despite loss at 6. month. All improvements after PR were similiar between groups. In 20 patients with one year follow up, while the improvements in dyspnea and body composition were preserved, both exercise capacity and quality of life decreased, exercise capacity was lower than values before PR. CONCLUSIONS: In patients with COPD, after multidisplinary PR program, the improvements in dyspnea, exercise capacity, quality of life were maintained during six months regardless of body composition and ONS duration. Furthermore, while the improvements in body composition, dyspnea, quality of life were protected, exercise capacity was found to be lower than baseline.

Comparison of the effects of neuromuscular electrical stimulation and endurance training in patients with severe chronic obstructive pulmonary disease.

INTRODUCTION: In severely disabled patients who are not capable of following formal pulmonary rehabilitation (PR) and/or tolerating higher training intensities, neuromuscular electrical stimulation (NMES) has been successfully utilized as a localized training method. MATERIALS AND METHODS: In this non-randomized controlled observational study 50 patients with severe chronic obstructive pulmonary disease (COPD), who were allocated into two groups. Endurance training group (ET) (n= 27) and NMES group (n= 23). To compare the effects of NMES and ET on health-related quality of life (HRQOL), exercise capacity, muscle strength, dyspnea, psychological status, and body composition in patients with severe COPD. Before and after PR program, the study parameters were assessed using the Medical Research Council (MRC) scale, incremental and endurance shuttle walking tests (ISWT, ESWT), manual muscle testing (MMT), the St. George's Respiratory Questionnaire (SGRQ), bioelectrical impedance analysis, and the Hospital Anxiety and Depression Scale (HADS). RESULTS: After the PR program, walking distance and endurance time significantly increased in both groups (p< 0.001 for each), whereas the MRC scores of both groups significantly decreased (p< 0.001 for each). In the ET group, significant decreases were noted in all domains of SGRQ and HADS. In the NMES group, significant improvements were observed in the HADS scores and in all SGRQ domain except symptom domain. No significant differences were observed between the NMES and ET groups regarding the changes from baseline to after PR program in walking distance (p= 0.140), endurance time (p= 0.376), the MRC (p= 0.540), HRQOL (p> 0.05) and HADS (p> 0.05) scores, body-mass index (BMI) (p= 0.49), fat-free mass (FFM) (p= 0.50) and fat-free mass index (FFMI) (p= 0.94). CONCLUSION: NMES can be used as an effective treatment strategy in PR programs for peripheral muscle training in patients with severe COPD.

[Pulmonary rehabilitation efficiency in COPD patients with pulmonary hypertension]. / Pulmoner hipertansiyonlu KOAH'li olgularda pulmoner rehabilitasyon etkinligi.

INTRODUCTION: COPD is among the most common causes for secondary pulmonary hypertension (PH). Pulmonary rehabilitation (PR) is recommended in the standard treatment of COPD. In this study, efficiency of multidisciplinary PR in COPD patients with PH was examined. PATIENTS AND METHODS: 88 patients stable COPD patients who applied to our center between 2008-2013 were enrolled. Un-likely PH patients were grouped as Group 1 while possible and likely PH cases were accepted as Group 2. There were no other cause for PH. All the patients received patient-specific, multidisciplinary 8-week PR. Dyspnea perception was assessed via MRC dyspnea scale, health-related quality of life with S. George life quality questionnaire, exercise capacity via incremental shuttle walking test and endurance shuttle walking test and body composition via bioelectrical impedance test before and after PR program. RESULTS: In all the patients there were significant improvements in body composition (BMI p= 0.013), quality of life (SGRQ semp., activity, total p< 0.001), dyspnea perception (MRC p< 0.001) and exercise capacity (ISWTT, ESWT, VO2 peak p< 0.001) after PR program. Improvements in Group 2 were observed to be significantly greater. CONCLUSION: PR is an effective and safe option in COPD patients with PH. These patients should be directed to PH programs for supervised exercise training and chronic disease management and patient-specific PR programs should be established.

Effect of nutritional status in individuals with chronic obstructive pulmonary disease undergoing pulmonary rehabilitation.

BACKGROUND AND OBJECTIVE: Chronic obstructive pulmonary disease (COPD) is considered a worldwide major public health problem. Weight loss, muscle and fat mass depletion are common nutritional problems in COPD patients and are determinant factors in pulmonary function, health status, disability and mortality. We aimed to assess the relationships between nutritional status and perception of dyspnoea, pulmonary function tests (PFT), exercise capacity and health-related quality of life (HRQoL) using the subjective global assessment (SGA) in COPD patients who were referred for pulmonary rehabilitation programme. METHODS: A total of 163 patients with stable COPD who are candidates for outpatient pulmonary rehabilitation programme were included in this study. Nutritional status for all patients was assessed by SGA. Association of SGA scores (A, B and C) and anthropometric measurements, PFT, dyspnoea scales (Medical Research Council and resting BORG scale), HRQoL (St. George Respiratory Questionnaire and Chronic Respiratory Diseases Questionnaire) and exercise testing (shuttle walking test) were studied for statistical significance. RESULTS: Based on SGA, 9.2% of patients were severely malnourished (SGA-C). There were significant decreases in forced expiratory volume in the first second (FEV1 ) (P = 0.009), Medical Research Council scales (P < 0.001) and exercise capacity (incremental shuttle walking test (P = 0.001) and endurance shuttle walking test (P = 0.009)) in SGA-C. Deterioration in anthropometric measurements and HRQoL measures were observed in malnourished patients. CONCLUSIONS: Identifying the nutritional status and determining any requirement for nutritional supplement is an important component of comprehensive pulmonary rehabilitation programme. SGA is an easy and practical method to assess nutritional status in pulmonary rehabilitation candidate patients with stable COPD.

Can exercise capacity assessed by the shuttle walk test predict the development of post-operative complications in patients with lung cancer?

INTRODUCTION: The objective of this study was to assess the role of shuttle walk test in predicting post-operative complications in lung cancer resection surgery. PATIENTS AND METHODS: A consecutive series of patients who were candidate for lung resection surgery with the diagnosis of early stage lung cancer were included to this study. All patients in this study evaluated for exercise capacity testing with shuttle walk test. RESULTS: Twenty for patients were included in this study. Mean age was 61.5 ± 8.6 years. Pneumonectomy, lobectomy, bilobectomy and wedge resection were performed in 11 (46%), 10 (42%), 2 (8%), and 1 (4%) patients, respectively. Complications occurred only in six patients. There was no statistically significant relationship between risk for development of post-operative complication and age, incremental shuttle walk test, endurance shuttle walk test and exercise capacity evaluated with peak VO2 (mL/kg/minute) (p> 0.05). CONCLUSION: Shuttle walk tests (incremental and enduronce) had a limited role in predicting post-operative complications in lung cancer resections.

Pulmonary rehabilitation in interstitial lung diseases.

INTRODUCTION: Interstitial lung diseases are characterised by dyspnea on exertion, low quality of life, cough and exercise intolerance. The aim of this study was to evaluate the effects of comprehensive pulmonary rehabilitation in patients with interstitial lung disease. MATERIALS AND METHODS: Data from patients who were referred to pulmonary rehabilitation with the diagnosis of interstitial lung diseases were included to this study. Ten patients with interstitial lung disease participated to our outpatient, 8 weeks, comprehensive pulmonary rehabilitation programme. Dyspnea was assessed with the Medical Research Council (MRC) scale; health related quality of life was assessed with the St.George's Respiratory Questionnaire (SGRQ). Exercise capacity was measured using the incremental shuttle walk test (ISWT) and endurance shuttle walk test (ESWT); anxiety and depression were assessed with the hospital anxiety depression scale (HADS). All parameters were recorded before and after pulmonary rehabilitation programme. RESULTS: Dyspnea sensation, anxiety and depression scores decreased after pulmonary rehabilitation (p: 0.023, p: 0.026, p: 0.039 respectively). Also impact domains of SGRQ significantly reduced (Z= 1.988; p= 0.047).The difference between median values of ISWT results before and after pulmonary rehabilitation was 60 meters. Although it was not statistically significant (Z= 1.863; p= 0.063), the level of increment was higher than the minimaly important clinical differance for ISWT. CONCLUSION: Our results showed that comprehensive pulmonary rehabilitation programmes were benefical for patients with interstitial lung diseases and it should be regarded as a standard care in this population from the early stages.

Hospital-at-home for chronic obstructive pulmonary disease exacerbation: Will it be an effective readmission avoidance model?

OBJECTIVES: Hospital-at-home (HAH), a pioneering health care model, is an accepted alternative to hospital treatment for patients with a chronic obstructive pulmonary disease (COPD) exacerbations. The aim of the present study was to analyze the effectiveness of HAH for patients with COPD exacerbations. METHODS: Two hundred six patients with COPD exacerbations who were admitted to our emergency room (ER) received the HAH model between January 2008 and March 2010. The number of patient's hospitalization, admission to emergency room, unscheduled outpatient attendance, and the length of stay in hospital (day) were recorded before and after a one-year period of HAH. RESULTS: After a one-year follow-up period of the HAH program, the number of patient who had hospitalization, admission to ER, unscheduled outpatient attendance rates was decreased 41.3%, 54.4%, 49.5% respectively. The decreases for all parameters were found to be statistically significant (P < 0.001). Additionally the total number of length of stay in hospital (day) after a one-year period after HAH was decreased (46.5%). CONCLUSION: Integrated care services, including home care units where HAH models are performed, are necessary to improve the health of patients with COPD, as well as to better manage their condition in terms of disease burden. Physicians should consider this form of management, especially because there is increasing pressure on inpatient bed requirement in Turkey.

Efficacy of pulmonary rehabilitation for bronchiectasis and related factors: which patients should receive the most treatment?

INTRODUCTION: Pulmonary rehabilitation (PR) is an effective approach for patients with chronic pulmonary disease, and it is also recommended for patients with bronchiectasis. The aims of the current study were to evaluate the efficacy of a multidisciplinary PR program and identify factors associated with improvement in patients with bronchiectasis. Material and ethods: We obtained data from patients with bronchiectasis who completed our PR program which consisted of education and training regarding bronchial hygiene. Pulmonary function test results, body composition, exercise capacity, quality of life, and psychological status were assessed before and after the PR program. RESULTS: We enrolled 130 patients in this retrospective study. Most patients had a history of pneumonia. The Medical Research Council (MRC) dyspnea scale, incremental shuttle walking test (ISWT), endurance shuttle walking test (ESWT), St. George's Respiratory Questionnaire (SGRQ), Chronic Respiratory Questionnaire (CRQ), and Hospital Anxiety and Depression (HAD) scores statistically improved after the PR program (all p < 0.001). Improvements were similar regardless of sex, etiology, smoking sta-tus, or number of hospitalizations. Age was negatively correlated with ΔSGRQ (p = 0.024, r = -0.203). Baseline forced expiratory volume in 1s (FEV1) was positively correlated with ΔCRQ (p = 0.015, r = 0.213) and negatively correlated with Δanxiety (p = 0.014, r = -0.215). Baseline MRC was negatively correlated with ΔMRC (p < 0.001, r = -0.563) and ΔSGRQ (p < 0.001, r = -0.308). Baseline ISWT was negatively correlated with ΔISWT (p = 0.043, r = -0.176) and Δanxiety (p = 0.007, r = -0.237). Baseline SGRQ was negatively correlated with ΔMRC (p = 0.003, r = -0.267) and ΔSGRQ (p < 0.001, r = -0.648). CONCLUSIONS: Our PR program is efficacious for patients with bronchiectasis regardless of sex, etiologic cause of bronchiectasis, concomitant chronic obstructive pulmonary disease, smoking status, and/or number of hospitalizations. Improvement varied among patients which highlights the need for more studies to determine which patients will benefit most from the program.

Influenza and pneumonia vaccination rates in patients hospitalized with acute respiratory failure.

Background and method: Despite their proven effect, the rates of vaccinations are low. The aim of this study was to determine the rates and associated factors of influenza and pneumonia vaccinations in patients who were hospitalized because of acute respiratory failure. Patients hospitalized because of acute hypoxemic or hypercapnic respiratory failure were recruited for this retrospective study. A survey was conducted with 97 patients. Primary diagnoses, ages, reasons of hospitalizations, education status, vaccination rates, information resources, and thoughts about vaccinations were recorded.Results: In total 45 (46%) of the patients were female, and 52 (54%) were male. The mean age was 67 ± 12 years. The primary diagnoses were lung disorders (n = 77, 79%), cardiac disorders (n = 16, 17%), and neuromuscular disorders (n = 5, 4%). In total 72 (74%) patients had chronic obstructive pulmonary disease (COPD) with primary lung disorders. All patients were hospitalized due to acute respiratory failure. The main reason for acute respiratory failure was infection in 40 patients (42%). The overall influenza and pneumococcal vaccination rates were 26% and 15%, respectively; for patients with COPD it was 30% and 17%, respectively. The main providers of information were doctors (42%). Vaccination status was not associated with infections or other reasons of hospitalization, age, sex, educational status, and number of hospital admissions in the previous year. A total of 51 patients (52%) had no belief in the benefits of vaccinations.Conclusion: Vaccination rates were found to be low in patients who were frequently hospitalized. Vaccination status was not related with hospitalization due to infections and history of hospitalization; awareness of vaccinations should be improved both in doctors and patients.

Comparison of unsupervised home-based pulmonary rehabilitation versus supervised hospital outpatient pulmonary rehabilitation in patients with chronic obstructive pulmonary disease.

Background: Pulmonary rehabilitation (PR) is an effective treatment in patients with chronic obstructive pulmonary disease (COPD) but still underutilized. The aim of this study was to compare unsupervised home PR with supervised outpatient PR in terms of various clinical variables in COPD patients.Methods: We conducted retrospective study consisting of 247 patients with COPD who were categorized into three group. 127 patients underwent unsupervised home PR, of whom 60 (47%) completed program (finishers), 67(53%) were lost to follow-up (non-finishers), 120 completed supervised outpatient PR. We compared baseline, post-treatment changes in demographic, clinical variables.Results: Sex, age were statistically similar between groups. Finishers of home PR had higher exercise capacity (p = 0.003), quality of life (p = 0.045), FEV1 (p = 0.001), lower pack-year smoking (p < 0.001) than outpatient PR.After home PR, exercise capacity (p < 0.05), quality of life (p < 0.001), dyspnea(p < 0.05), anxiety (p < 0.001), depression (p < 0.001) were improved except endurance shutte test. Improvements in exercise capacity (p < 0.05), quality of life (p < 0.001), dyspnea (p = 0.023), anxiety (p < 0.001), depression (p = 0.001) scores were different between completed PR programs, in favor of supervised outpatient PR. Non-finishers of home PR had more pack-year smoking than finishers of home PR (p = 0.039); other baseline parameters were similar.Conclusion: Unsupervised home PR was effective in terms of improving exercise capacity, quality of life, dyspnea, psychological status, but less than supervised outpatient programs.

The Efficacy of Outpatient Pulmonary Rehabilitation After Bilateral Lung Transplantation.

PURPOSE: Pulmonary rehabilitation (PR) is advocated in the pre- and post-lung transplantation (LTx) periods. However, there is limited literature on the benefit of PR post-LTx. The aim of this study was to investigate the efficacy of an outpatient, multidisciplinary, comprehensive PR program in bilateral LTx recipients in the early period after LTx. METHOD: Twenty-three LTx recipients were referred to the PR center. Change in incremental and endurance shuttle walk tests, hand and quadriceps strength, respiratory muscle strength (maximum inspiratory/expiratory pressure), dyspnea (Medical Research Council score), quality of life (St George's Respiratory Questionnaire, Chronic Respiratory Questionnaire), and psychological status (Hospital Anxiety Depression Scale) were compared pre- and post-PR. RESULTS: Seventeen of 23 (74%) recipients completed PR, comprising 15 male and 2 female patients whose median age was 51 yr. The initiation of the program was 75 ± 15 d after LTx. The incremental shuttle walk test distance was predicted as 23% before PR and it increased to 36% after PR (P < .001); the endurance shuttle walk test distance also increased (P < .01). Significant improvement was seen in upper and lower extremity strength, and St George's Respiratory Questionnaire and Chronic Respiratory Questionnaire scores and Hospital Anxiety Depression Scale scores reflected less anxiety and depressive symptoms. Furthermore, body mass and fat-free mass indices, maximum inspiratory pressure, and maximum expiratory pressure improved significantly. There was no significant change in forced expiratory volume in the first second of expiration, forced vital capacity, or Medical Research Council scores. CONCLUSION: This study demonstrated that patients who attended PR within 3 mo of bilateral LTx showed improvements in exercise capacity, respiratory muscle strength, quality of life, body composition, and psychological status.

Relation between upper-limb muscle strength with exercise capacity, quality of life and dyspnea in patients with severe chronic obstructive pulmonary disease.

INTRODUCTION: In chronic obstructive pulmonary disease (COPD), skeletal muscle weakness is characterized by reduced muscle strength, reduced muscle endurance and the presence of muscle fatigue especially in lower limbs. There has been little research into the upper limb skeletal muscles. OBJECTIVES: In this study, we aimed to investigate the relation of upper limb muscle strength with pulmonary function, exercise capacity, quality of life (QoL) and dyspnea sensation. METHODS: Eigthy-eight patients (89.8% male; age: 64.2 ± 8.7 years) with COPD (FEV1 = 34.2% ± 15.2%) were evaluated. Tests included hand grip strength and actual 1-repetition maximum (1RM) test for upper limb strength. Dyspnea sensation was assessed with medical research council (MRC) scale. St. George Respiratory Questionary (SGRQ) was used to evaluate patients health related QoL. Exercise capacity was evaluated with incremental shuttle walk test and endurance shuttle walk test. RESULTS: Upper limb muscle strength correlated with exercise capacity but no correlations were found with pulmonary functions.There were negative correlations with all the domains of SGRQ both actual 1RM and handgrip strength. MRC scores revealed a negative correlation with upper limb muscle strength. CONCLUSION: In our study, we showed that upper limb muscle strength correlated with exercise capacity, QoL, dyspnea sensation. Identifying patients who have greater reductions in strength will allow early interventions with a multidisciplinary manner.

The Comparison of Clinical Variables in Two Classifications: GOLD 2017 Combined Assessment and Spirometric Stage of Chronic Obstructive Pulmonary Disease.

BACKGROUND: There are limited number of studies that investigate clinical variables instead of chronic obstructive lung disease (COPD) management according to Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2017 classification. The aim of the study was to investigate whether there was a difference between GOLD 2017 classification and spirometric stage in clinical variables in patients with COPD. The data of 427 male patients with stable COPD were investigated retrospectively. METHODS: Patients were allocated into combined assessment of GOLD 2017 and spirometric stage. Age, amount of smoking, pulmonary function, modified Medical Research Council (mMRC), incremental shuttle walk test (ISWT), Hospital Anxiety-Depression Scale (HADS), St. George's Respiratory Questionnaire (SGRQ), body mass index (BMI), and fat free mass index (FFMI) were recorded. RESULTS: Seventy-three (17%) patients were in group A, 103 (24%) constituted group B, 38 (9%) were included in group C, and 213 (50%) comprised group D according to the combined assessment of GOLD 2017. Twenty-three patients (5%) were in stage 1, 95 (22%) were in stage 2, 149 (35%) were in stage 3, and 160 (38%) were in stage 4 according to spirometric stage. According to GOLD 2017, age, amount of smoking, mMRC, BMI, FFMI, SGRQ, HADS, forced vital capacity, forced expiratory volume in 1 second (FEV1), and ISWT were significantly different between groups. Ages, amount of smoking, FFMI, BMI, HADS of group A were different from B and D. Smiliar values of FEV1 were found in A-C and B-D. A and C had smiliar ISWT. According to spirometric stage, BMI, FFMI of stage 4 were statistically different. mMRC, ISWT, and SGRQ of stages 3 and 4 were different from other stages, amongst themselves. FEV1 was correlated with mMRC, SGRQ, anxiety scores, BMI, FFMI, and ISWT. CONCLUSION: This study showed that the GOLD ABCD classification might not represent the severity of COPD sufficiently well in terms of lung function or exercise capacity. The combination of both spirometric stage and combined assessment of GOLD 2017 is important, especially for estimating clinical variables.

Efficacy of a multidisciplinary pulmonary rehabilitation outpatient program on exacerbations in overweight and obese patients with asthma.

BACKGROUND: Even though many studies have investigated the effectiveness of weight loss interventions, the efficacy of pulmonary rehabilitation (PR) has not yet been proven in obese patients with asthma. The aims of this study were to investigate the efficacy of PR on asthma exacerbations in the first year after PR and to evaluate the efficacy of PR in exercise capacity, quality of life, psychosocial symptoms and control of asthma in overweight patients. METHODS: The exercise capacity, health-related quality of life scores, psychosocial symptoms, asthma control test (ACT) data, number of emergency admissions and hospitalizations of 35 overweight patients with asthma who completed a 1-year multidisciplinary PR program were recorded and analyzed. RESULTS: Of the participants 30 were female, the mean age was 45 ± 9 years, 13 (37%) patients were overweight and 22 (63%) were obese. The average number of emergency admissions (from 1.2 ± 1.1 to 0.3 ± 0.8) and hospitalizations (from 0.6 ± 0.9 to 0.0 ± 0.1) decreased significantly 1 year after PR (both p<0.001). After PR, statistically significant improvements in exercise capacity as measured by the incremental shuttle walking test (ISWT) from 281 ± 104 m to 339 ± 95 m (p < 0.001), the endurance shuttle walking test (ESWT) from 13.3 ± 7.4 min to 17.5 ± 4.5 min (p = 0.005), quality of life measured by the St. George's respiratory questionnaire (SGRQ total from 64 ± 14 to 28 ± 10, p < 0.001), dyspnea sensation with the Medical Research Council (MRC) scale (from 2.6 ± 0.6 to 2.1 ± 0.4, p <0.001) and hospital anxiety depression scores (HADS, anxiety score from 9.9 ± 1.6 to 7.1 ± 2.1, depression score from 9.4 ± 1.9 to 7.2 ± 2.3, both p < 0.001) were found. A reduction in body mass index (BMI) was found in obese patients only, but the fat-free mass index (FFMI) improved in both overweight and obese patients (from 19.00 ± 1.90 to 19.45 ± 2.04, p = 0.01). The mean ACT score increased significantly (from 18 to 21 points, p < 0.001). The number of patients with poorly controlled asthma decreased from 21 (60%) to 10 (28%). CONCLUSION: This study showed that comprehensive multidisciplinary PR was associated with a decreased number of emergency admissions and hospitalizations for asthma exacerbations in 1 year, and improvements of dyspnea sensation, quality of life, exercise capacity, and psychosocial status in overweight and obese patients.

Chronic necrotizing pulmonary aspergillosis presenting as transient migratory thoracic mass: A diagnostic dilemma.

Chronic necrotizing pulmonary aspergillosis (CNPA) is a rare form of pulmonary aspergillosis. The radiological findings in CNPA are very diverse. We present a mildly imunosuppresive, elderly 71-year-old woman with the diagnosis of chronic necrotizing pulmonary aspergillosis presenting as transient migratory thoracic mass.

Neuromuscular electrical stimulation as an adjunct to endurance and resistance training during pulmonary rehabilitation in stable chronic obstructive pulmonary disease.

AIM: The purpose of this study was to investigate whether adding neuromuscular electrical stimulation (NMES) to a comprehensive pulmonary rehabilitation (cPR) program would have additive effects on clinical-functional outcomes. METHODS: Twenty-seven chronic obstructive pulmonary disease patients participating in a 10-week cPR program were randomly allocated to NMES + cPR (n = 13) or Sham + cPR (n = 14) groups. Quadriceps strength, exercise capacity, symptoms, mood, activities of daily living and quality of life were evaluated pre- and post-interventions. RESULTS: There were no significant differences in any of the physiological and subjective improvements induced by NMES + cPR versus Sham + cPR (p > 0.05). In fact, the NMES + cPR group showed lower increases in incremental shuttle walk test (ISWT) distance (38.4 vs 69.2 m, respectively) and %ISWT distance (5.1 vs 9%, respectively) compared with the Sham + cPR group (p < 0.05). CONCLUSION: The increase in exercise capacity is less important when NMES is used as an adjunct to the cPR.